Each month, the American Telemedicine Association broadcasts This Month in Telemedicine, a webcast discussing news and topics in the telemedicine field. February’s webcast featured ATA’s Jonathan Linkous, Chief Executive Officer, and Gary Capistrant, Senior Director of Public Policy, discussing the growth of telemedicine and policy issues.
A deluge of demand, a raft of pending legislation, and licensing challenges—these are a only a few of the issues facing telemedicine.
Telemedicine is undergoing an “explosion of activity,” says Linkous. The ATA estimates 10 million patients in the U.S. and Canada are now using telemedicine (the majority for radiology). Two trends he’s seeing: the involvement of patient groups, who are showing interesting and researching how telemedicine could be employed by their members, and the growth of “big med” across the country.
The ATA is anticipating the demand will only grow—possibly reaching 50 million patients in the next couple of years. The question is whether providers, telemedicine networks, and vendors will be able to meet the growing need for telemedicine services. Linkous calls this, “A serious issue we need to focus on.”
“We’re moving away from the fee-for-service model,” says Linkous. “We’re moving to managed care, accountable care, medical homes.” This is good news for telemedicine, he says.
New developments in telemedicine include specialty service providers—a group that’s appeared in the past couple of years. To help track this growth, ATA created a new service provider forum of private companies that provide direct services to patients.
Also, a few major companies are offering online consultations, including American Well and TelaDoc. And insurance plans are also expressing interest in the potential of telemedicine. Several major plans now reimburse patients for online consultations, but only in a few states so far. Some are offering the service as an add-on to traditional care for an additional fee. However, while patients can get prescriptions online, they won’t for controlled substances, in compliance with federal law. “You will not see that done,” says Linkous.
With health care reform becoming a reality, a large number of people are expected to be added to Medicaid, and states don’t know how they’re going to accommodate the increase in Medicaid demand. The ATA sees telemedicine as an answer to that problem.
A big issue with telemedicine is licensing. Each state has its own licensing board. About 22% of doctors have licenses in more than one state, and the ATA estimates this costs $300 million per annum, paid to states for 2nd, 3rd, and 4th licenses. They’re looking to the model established by the Department of Defense and approved by Congress last year—their doctors only need to be licensed in one state. Several states have proposals to follow the D.O.D.’s lead, but that’s a cause for consternation for the medical boards, who are looking at a major loss of income if this licensing model is actually established nationwide.
For health systems and private companies that are telemedicine focused, health care provider licensing is a subject they’re following closely. “There are concerns that an agreement requiring approval by each state could mean years of delay,” says Linkous.
California Congressman Mike Thomas introduced a bill (The Telehealth Promotion Act) with the aim of increasing federal acceptance of telemedicine, which would include Medicaid, the V.A. medical system, and other federal health programs. The licensing model proposed with this bill is one where health care providers need only be licensed in their own state, and the patient’s location would be deemed irrelevant.
Policy & Legislation:
“We’ve never had so many bills introduced at state level,” says Gary Capistrant. There are 13 states plus D.C. that have legislation pending to mandate private insurance coverage of telemedicine services (15 states already have this as law). 11 states are expanding Medicaid coverage to ensure parity with in-person health care. He suggested the Thompson Bill might be segmented to smooth the commitment process.
As of March 1st, 2013, California, Texas, and Vermont are the only states that have legislation for both private and Medicaid coverage; 14 other states have a legislated mandate for private coverage, and only Pennsylvania and Nebraska have it for Medicaid. But 24 states have proposals on the table for either are both. You can see the full list here. To help track state telemedicine information and changes, the ATA has set up atawiki.org—click on Current Events, or type in a state in the search box for the latest info.